Why Not Let Patients Give Up the Right to Sue Their Doctors?

Photo credit: CmdrCord / Foter.com / CC BY-NC-SAPhoto credit: CmdrCord / Foter.com / CC BY-NC-SAHealth reformers often talk about tweaking the medical reimbursement system in order to create better incentives for providers to hold down costs or increase quality. But one incentive that’s frequently overlooked is the incentive to avoid being sued. Right now the incentive is pretty strong in part because health providers have essentially no way to make a binding agreement with patients that limits that patients’ ability to sue.

In The New York Times, University of Chicago economist Richard Thaler suggests experimenting, on a limited scale, with letting some high-quality health providers require that patients give up their right to sue for bad health results as a condition of service. Here’s his pitch:

Thus, to encourage high-quality health care providers to adopt sensible practices, let’s offer an inducement. Those with a record of providing high-quality care at good value could apply to the government for a safe harbor from malpractice suits. Organizations that receive this status could require patients to waive their right to sue for adverse outcomes. Of course, no patient would be forced to stick with such a provider, and with the new rules on pre-existing conditions under the health care reform law, those who wanted to retain their right to sue could go elsewhere. And an organization could lose this right if its quality declines.

Courts have previously ruled that such waivers are illegal, presumably because they do not believe patients should be trusted to make this judgment, but the experiment I suggest can test this concept in a limited way, starting with only the highest quality providers.

Personally, I would gladly give up my right to sue. Maintaining it is implicitly costing me money, for which I get little in return. Over the past five years, malpractice insurance companies have paid out to patients only 37 percent of the premiums they collect, according to the National Association of Insurance Commissioners. About 40 percent of that money goes to lawyers, meaning that patients end up with less than a quarter of the dollars that doctors and hospitals pay for insurance. That is a return that makes state lotteries look like good investments.

Right now the court system generally does not trust patients to make their own decisions about whether or not to give up the right to sue their medical providers. That adds to the expense of health care because it means that doctors take sometimes costly extra steps to avoid being sued, performing tests or other procedures that in all likelihood are unnecessary. It’s hard to say what sort of savings this might produce; if I had to guess, the aggregate savings would be of moderate size at best, and possibly very small, but individual savings could be large. As Thaler notes, tort reform is complicated, and at least one prominent attempt to restrain malpractice costs — legislation in Texas capping noneconomic awards for malpractice at $250,000 — did not result in savings.

But the potential for savings is only one reason to try something like Thaler’s idea. The other is to start the process of freeing patients and doctors from a paternalistic legal system that operates under the assumption that patients are incapable of making their own decisions about their health and medical care.

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  • Jesus H. Christ||

    First!

  • Aresen||

    Omega.

  • Jesus H. Christ||

    Ha! Suckit!!!

    Anywho, why not allow someone to pay a certain amount for a procedure with a contractual cap on the potential payout if a suit occurs, probably based in part on the procedure? Charge a lower price if the patient agrees to not sue at all?

    I see this only working IF the patient is actually aware of the cost and has an incentive to pay less, ie. they pay the bill themselves.

  • Aresen||

    Another option: Have patients pre-buy 'bad outcome' insurance, with a pre-determined scale of payout.

  • Alice Bowie||

    This is done in denmark.

    No one can sue a doctor.
    All patients MUST buy the insurance, no option.
    And, their version of the AMA revokes licences of crappy doctors.

  • Stormy Dragon||

    Suppose I only agree to sell you widgets if you agree to a contract stating I cannot be sued as a result of our transaction. Further more, suppose I do this with knowing that I intend to run off with your money without delivering any of the widgets. If I do so, are you actually prevented from suing me to get the money back, or was the entire contract fraudulent and therefore void?

  • Virginian||

    Uh, so write the contract with a clause stating nondelivery of product is grounds for a lawsuit.

  • Stormy Dragon||

    So basically feel that in place of a law against misrepresentation, you should be responsible for exhaustively itemizing every way the other party could be defrauding you?

  • pmains||

    So, because you are unable to imagine how others would create and abide by rules that allow them to interact in a less adversarial way, nobody else should be allowed to do so. Everybody needs to be brought down to the lowest common denominator.

    This is a common attitude on the left, I've noticed. There needs to be a name for it.

  • Stormy Dragon||

    There also needs to be a name for assuming everyone disagrees with you about anything is a leftist.

  • Brandon||

    Dude, you are a leftist. Unless you're a different Stormy Dragon than the one who keeps posting leftist talking points here, in which case I apologize for calling you a leftist. Although you pretty much posted a standard lefty Reductio ad absurdum up there and then doubled down on it when Virginian called you on it, so I am not really willing to grant that you are a different one.

  • pmains||

    Maybe he's a Shikertarian.

  • Tulpa (LAOL-PA)||

    So, because you are unable to imagine how others would create and abide by rules that allow them to interact in a less adversarial way, nobody else should be allowed to do so.

    But if nobody is able to imagine how this can happen, maybe it's impossible. In which case SD's point is legit.

  • Virginian||

    For a simple purchasing of widgets? Yes. If you don't deliver them on time and as specified, you have broken the contract.

    Medical law is interesting, and tricky. If your car is broken, you replace parts until it isn't broken anymore. The human body doesn't work like that. Not yet anyway.

    If a mechanic screws up, it's all on him. But with a doctor he could have done everything perfectly, but the infection still spread. So no choice but to amputate. Patient sues, a jury of 12 people to stupid to avoid jury duty sees a weepy guy with no leg, and hey doctors have insurance, so they vote to give the guy money.

    There's no easy fix.

  • Tulpa (LAOL-PA)||

    I see a fix... don't avoid jury duty.

    This is one of my pet peeves on H+R... people boasting about getting out of jury duty and then complaining about the low quality of juries.

  • Virginian||

    Oh, I get where you're coming from. I've never been called, and if I was I know for a fact I'd be kicked out in voir dire. But that's kind of the problem. They select for easily convinced people. Someone who is skeptical of authority always gets kicked out in voir dire. Unless they lie.

  • Stormy Dragon||

    I'd love to be on a jury, but they never pick me! It's like kickball all over again.

  • Brandon||

    Tulpa, I haven't avoided jury duty in my life, but I have never been selected for a jury because I don't lie about my beliefs when asked. What would you suggest in this case?

  • Tulpa (LAOL-PA)||

    Maybe you should modify your beliefs to make yourself more acceptable?

  • Brandon||

    When did you become just a troll?

  • Stormy Dragon||

    In my mind, me on a jury is "12 Angry Men". In real life, me on a jury problem ends up being "The Jury Story".

  • EDG reppin' LBC||

    Stormy Dragon on a jury would be more akin to, well Jury Duty.

  • ||

    Me on jury duty would be like a cancelled TV show. And not one of the GOOD cancelled shows, like the ones on Fox.

  • Jesus H. Christ||

    Your scenario sounds like a pretty clear case of bad faith, so I would think you would still be liable.

  • Stormy Dragon||

    So what if I think the medical provider asked me to sign the no-sue medical contract in bad faith (The surgeon didn't tell me he was going to show up drunk that day!)? How do we resolve that dispute?

  • Jesus H. Christ||

    See John's response below.

  • Tulpa (LAOL-PA)||

    You could probably write the contract to exclude specific cases of gross negligence such as being intoxicated, or not washing your hands before surgery, or whatnot. But I agree that this "negotiation" is going to be more complicated than the author lets on.

  • pmains||

    How about doing it the other way? Instead of sitting around and trying to imagine all of the things that the doctor is liable for, list the risks that the patient is accepting.

  • John||

    If you agree to sell me widgets and then keep my money, I would have an action in equity to get my money back regardless of what the contract says. But there is nothing about contract law that requires there be a penalty or a right of action for every breached contract or even harm done to one of the parties. For example, some contracts contain liquidated damage clauses that basically allow one party to walk away from the contract in exchange for a payment.

  • ||

    freeing patients and doctors from a paternalistic legal system that operates under the assumption that patients are incapable of making their own decisions about their health and medical care

    But that's the point. The legal "system" will never let this cash cow opt out of it. It will unsurprisingly still allow lawsuits even though it's not supposed to (much like allowing birth parents to try and get back kids who they supposedly fully, willingly gave up to adoptive parents) because there's just so much fucking money in it and the people who staff the legal system--lawyers--recognize that and want a piece.

    If you think the lawyer parasites will let this go, you're insane. And they staff the system and many politicians are lawyers as well.

  • Brett L||

    I could be wrong here, but I don't think you ever "give up your right to sue" as long as you can find a lawyer who thinks they can make a case. I'm unclear on any mechanics that would allow that. Even getting the case dismissed with prejudice costs something up front. This seems like a pipedream.

    They could save the same money by passing a law limiting lawyers' take to no more than 15% of the damages awarded.

  • Eduard van Haalen||

    An old joke has the lawyer justifying his high fees by saying: "I won that case with my legal skills - any fool can get run over by a bus."

  • AlmightyJB||

    I agree. People will sue anyways and win. Would never pass anyways.

  • Adam330||

    If the law were enforced as written, then people could indeed file a suit, but it would dismissed very early on and there would be no damages. Patients then would have a very hard time getting a lawyer to take the case on contingency, which would make the suits essentially disappear.

  • Tulpa (LAOL-PA)||

    And that's not necessarily a good thing.

    Without lawyers working on contingency, non-rich people would have absolutely no means of suing even when they have a legitimate claim.

  • John||

    Thus, to encourage high-quality health care providers to adopt sensible practices, let’s offer an inducement. Those with a record of providing high-quality care at good value could apply to the government for a safe harbor from malpractice suits.

    I stopped reading right there. This guy wants to let top men decide that other top men should be able to opt out of the tort system. If he feels people ought to be able to bargain away their tort rights, fine, then let them bargain away such rights. But spare me the government telling us which top men are worthy of making such a bargain.

  • Brett L||

    Beyond that... what are the forseeable consequences? Bribery and other favor trading to get BigMedCo on the list, whether they provide "quality" or not. SmallCo getting blackballed despite having a better service record. Eventually, BigMedCo is going to tell docs to stop doing reasonable and necessary tests because they can't be sued anyhow. Did I leave any off?

  • Eduard van Haalen||

    +1

  • AlmightyJB||

    True dat

  • Tulpa (LAOL-PA)||

    I agree that there are manifold opportunities for cronyism in his proposal.

    I don't think just allowing people to bargain away their right to sue will work either. Most, if not all, doctors would immediately refuse to treat anyone who didn't give up their right to sue. And they can get away with this due to the barriers to entry into medicine. Malpractice insurance would disappear since the pool would shrink, and then you'd have ALL doctors refusing to treat without a waiver.

  • John||

    Maybe. But it might work differently. People might refuse to see doctors who wanted a waiver on the grounds that they were per say incompetent. People would be willing to pay a premium for the peace of mind of knowing their doctor was willing to stand behind his services.

    More than likely there would be some who ran low cost operations and demanded the waiver and others who ran high end ones who didn't. And I see no reason why malpractice insurance would go away since, the only doctors who could get by with not having the waiver would be ones who were unlikely to have a malpractice claim against them.

  • robc||

    Or, if most/all doctors adopted the waiver, patients would buy the malpractice insurance, instead of the doctors buying it.

  • robc||

    In fact, I believe this calls for a healthy dose of, wait for it:

    COASE COASE COASE COASE COASE COASE COASE COASE COASE
    COASE COASE COASE COASE COASE COASE COASE COASE COASE
    COASE COASE COASE COASE COASE COASE COASE COASE COASE
    COASE COASE COASE COASE COASE COASE COASE COASE COASE
    COASE COASE COASE COASE COASE COASE COASE COASE COASE
    COASE COASE COASE COASE COASE COASE COASE COASE COASE
    COASE COASE COASE COASE COASE COASE COASE COASE COASE
    COASE COASE COASE COASE COASE COASE COASE COASE COASE
    COASE COASE COASE COASE COASE COASE COASE COASE COASE
    COASE COASE COASE COASE COASE COASE COASE COASE COASE
    COASE COASE COASE COASE COASE COASE COASE COASE COASE
    COASE COASE COASE COASE COASE COASE COASE COASE COASE
    COASE COASE COASE COASE COASE COASE COASE COASE COASE

    This is a fucking coasean as you can get, as the difference in transaction costs between the doctor and the patient buying the insurance is fucking minimal.

  • robc||

    You would probably just throw a malpractice rider onto your basic health insurance policy.

  • Tulpa (LAOL-PA)||

    So where's the incentive for the doctor not to commit malpractice?

    And again, you're passing the costs from the rich person onto the poor person. Nice.

  • Brandon||

    Tulpa, I have never heard "manifold" used in that way. I actually had to look it up. Well done.

  • ||

    You poor, sheltered soul, you. I bet you've never seen "affect" used as a noun or "effect" used as a verb before either.

  • califernian||

    Right now the court system generally does not trust patients adults to make their own decisions about whether or not to give up the right to sue their medical providers. anything

    FTFY

  • Drake||

    The current system in most jurisdictions is risk free for the patient looking to sue. Transferring some risk to plaintiffs and their lawyers seems to work with "loser pays" rules.

  • Tulpa (LAOL-PA)||

    The only "risk" the doctor faces in a malpractice suit is his insurance rates going up.

    Under a loser pays regime, a non-rich patient with a legitimate malpractice claim is risking complete economic ruin by suing (and getting a lawyer on contingency won't help since it doesn't pay for the doc's lawyers). Not to get all 99% on you, but "loser pays" would be a boon for the rich and for big corporations and a bane of everyone else.

  • robc||

    I keep hearing this, but is there any evidence this is true from countries with loser pay systems?

  • Tulpa (LAOL-PA)||

    The biggest example of a loser pays system is in the UK, and they don't have a comparable medical system, obviously.

  • Stormy Dragon||

    1). How does loser pays rule applies in the vast majority of cases that end in a settlement?

    2). The current system also incentives the party with more resources to draw out the litigation process as much as possible in hopes of bankrupting the party with less sources. It seems to me that loser pays exacerbates the problem.

    3). There's something of a Catch-22 here: if the court's ultimate decision is based on the merit of the case and not the quality of the lawyers, why should I have to pay out more because you chose an unnecessarily expensive legal defense? If the court's aultimate decision is based on the quality of the lawyers and not the merit of the case, why does losing automatically confer illegitimacy to the loser's suit?

    4). If the jury knows John Little Guy also has to pay Big Corporations legal bills if you vote not guilty, is that going to make frivilous lawsuits more or less likely to succeed?

  • Rasilio||

    Loser pays doesn't work because it assumes that all cases won by the defendant were groundless.

    There is a rather large area between a judgement for the plaintiff and a frivolous case that never should have been brought or someone attempting to use the tort system as a lottery ticket.

    So the rule needs to be set up such that you get 3 outcomes -

    Judgement for the Paintiff - The defendant is responsible and has to pay appropriate damages

    Judgement for the Defendant - The defendant is not responsible however there was probable cause to bring the suit

    Judgement against the Plaintiff - Not only is the defendant not responsible, there was never any rational grounds for the suit and therefore both the Plaintiff and their attourney are responsible for reimbursing the court and the defendant for their expenses

    That said there also needs to be another change, we need a tort system which is much harder on plaintiffs because right now in far too many cases all that it is necessary to do is show that the plaintiff has suffered some adverse outcome and the defendant will end up paying, even if there is no evidence that they did anything wrong to cause the harm.

  • Tulpa (LAOL-PA)||

    This is the system I would prefer as well. But can't a judge declare a lawsuit frivolous in the early stages and order the plaintiff to pay for the defendant's legal expenses under current law, too?

  • Rasilio||

    In at least some places they can throw it out as frivalous, I've never heard of their being able to force the plaintiff to pay the defendants legal expenses. Not a lawyer but I suspect that under current law if a judge tried that it would be thrown out as a violation of the plaintiffs civil rights (denying their access to the tort system).

    That said, it just leads to the second part of my post. I don't know WHY this is so, but judges don't ever seem willing to throw out patently frivolous suits and Juries are far to willing to be swayed by sob stories.

    We could switch to full on loser pays and it wouldn't change much right now unless there are changes made which require that the defendant be shown to be legally responsible for the damage, not just that damage was done before a judgement can be issued against them.

  • Tulpa (LAOL-PA)||

    Apparently 28 USC § 1912 allows this in the Federal Courts. Also attorneys can be fined for making frivolous arguments.

  • John||

    We have loser pays in civil rights suits and those areas of law function. Loser pays benefits deserving plaintiffs as much as it does innocent defendants. Right now an insurance company faces very little risk by dragging a deserving claim out. They pay their attorneys no matter what. So they drag the case out as long as possible hoping the claimant gets desperate and takes less than they deserve. If they were faced with paying the other guy's attorney's fees, that would not be advantageous anymore and they would pay deserving claims in a timely manner.

  • Tulpa (LAOL-PA)||

    So they drag the case out as long as possible hoping the claimant gets desperate and takes less than they deserve.

    Which would be exacerbated by the claimant's risk of having to pay for the insurance company's lawyers if the verdict goes the other way.

  • John||

    If the claimant has a legitimate case, there isn't much risk of his having to pay.

  • Rasilio||

    Ok here is the better solution...

    If you sue just because there was a bad outcome with no realistic evidence that there was malpractice (which includes failure to explain the risks) then you get laughed out of court and are issued a fine equal to 200% of the Courts and defendents costs for wasting the courts valuable time.

    Oh and if you have legal representation for such a case the lawyer is responsible for 80% of the fine unless he can show that you materially misrepresented the case to him.

    However you should ALWAYS have the right to sue for suspected malpractice with no threat of having to pay expenses out of your pocket, even of the Dr in the end prevails.

  • Adam330||

    What percent of their revenues do doctors pay in malpractice premiums? I'm sure it varies a lot by speciality, geography, and claims history, but what's the average?

  • The Late P Brooks||

    A few months ago, I paid a dentist for what amounted to nothing but giving me the name of a different dentist.

    If we want to rein in actual health care costs, we could start with bullshit like that.

    Yesterday, they were talking about health care on Stephahoosis' show. George Will made the obvious point about transparency on pricing; I believe he said only $.12 of the average health care dollar is paid by the direct recipient of the service. Of course, the counter was, "BUT OMFG YOU'RE DYING AND YOU DON'T HAVE TIME TO SHOP AROUND!!!!!@"

    I would be delighted to know what percentage of medical costs are truly not-a-second-to-lose emergencies. I'll go out on a limb and say a whole lot less than last dying breath care.

  • Rasilio||

    "George Will made the obvious point about transparency on pricing; I believe he said only $.12 of the average health care dollar is paid by the direct recipient of the service."

    Even worse, if you go add up all of the various federal and state health care programs $0.70 of every dollar is paid for by some level of government

  • Brandon||

    And how much of that .70 goes to governmental overhead? Half?

  • John||

    Yesterday, they were talking about health care on Stephahoosis' show. George Will made the obvious point about transparency on pricing; I believe he said only $.12 of the average health care dollar is paid by the direct recipient of the service.

    So what? They are paid by insurance companies who last I looked have just as much reason to save their money as you do yours. Why this idiotic point won't die is beyond me.

  • Brandon||

    The point is, this would remove a great deal of the incentive for people to use insurance, or to stay with regular co-pay plans instead of high-deductible catastrophic coverage plans.

  • John||

    That doesn't even make any sense. People avoid catastrophic plans because they are risk adverse and are willing to pay more to avoid risk.

  • Brandon||

    No they don't. They avoid catastrophic plans because they are not informed about how little they would have to pay for routine crap without it going through insurance.

  • Tulpa (LAOL-PA)||

    Except the insurance company has to cover everything laid out in the insurance agreement. They don't have a choice of whether to pay or not.

    If I'm paying for X-Rays after a car accident in which I don't feel badly hurt, I'm probably going to skimp. If the insurance company is paying for them, they can X-ray me until I glow like Dr Manhattan.

  • The Late P Brooks||

    "I won that case with my legal skills - any fool can get run over by a bus."

    Excellent.

  • The Late P Brooks||

    There also needs to be a name for assuming everyone disagrees with you about anything is a leftist.

    Or it could, you know, be a judgement based on historical evidence.

  • The Late P Brooks||

    Without having read any of this stuff in detail, what are the chances an enhanced screening and arbitration process (funded by providers and insurers) could materially improve the situation?

  • John||

    We already have that in most states. You have to get a board of doctors to agree that there was malpractice to go forward in many states.

  • The Late P Brooks||

    Why this idiotic point won't die is beyond me.

    What we have currently is a situation in which patients wander into doctors' offices and hand them what amounts to a blank check. This is ineffective as a constraint on prices.

    Sorry if that confuses you.

  • John||

    But they don't have a blank check. They have whatever their insurance company will pay for and not a penny more unless they want to pay for it.

    Do you really think insurance companies hand out blank checks? They just pay whatever doctors' bill them and cover any procedure the patient wants? That is Tony level retardation Brooks. And it is fucking gospel among a lot of people who should know better.

  • John||

    Sorry if it confuses you that insurance companies don't print their own money.

  • The Late P Brooks||

    The insurance company sees the bill after the fact. And the haggling is done behind the curtain.

    There should be billboards along the highway, just like for boob jobs and Lasik.

    "I'll fix your hip for $24,999!"

  • John||

    The insurance company sees the bill after the fact. And the haggling is done behind the curtain.

    Yeah and the poor defenseless insurance companies just take it up the ass. That is what they do. They are not business that have every reason to cut costs. Nope, they just pay whatever bill is sent to them. Jesus fucking Christ Brooks, get your head out of your ass and think about this. You are basically arguing that insurance companies operate like no other business on earth. Come on, try harder. I know you are not this fucking stupid.

  • Brandon||

    There has to be some reason that cosmetic surgery and laser vision correction are continually getting better and cheaper. I would think the lack of insurance involvement is as strong a reason as anything else.

  • John||

    It might be that these surgeries involve technology that is easier to master. Also, lots of other medical procedures are getting cheaper. The difference is that they are immediately replaced by something better and more expensive. People tend to want the best medical care they can get.

    There are reasons why medical costs are high. Some of that is because of the government fucking with the market. But some of it is because we are a rich country and have a lot of money and people really value medical care. That tends to drive prices up.

    But what is not driving prices up is people pooling risk via insurance. Insurance doesn't drive the price of home repair or car repair up. Yet for some reason Libertarians throw out every ounce of economic analysis when looking at medical insurance.

  • Tulpa (LAOL-PA)||

    Insurance doesn't drive the price of home repair or car repair up.

    Auto insurance doesn't cover most car repairs so that's a red herring. If you're thinking about warranties it's hard to say, since most of them require that the work be done by one of their dealers.

  • Brandon||

    Well, Tulpa covered this red herring.

  • John||

    Well so what if they are? Does that mean auto insurance is a bad deal? Should we ban all insurance because it may result in the evils of high prices?

    At most your case is that insurance produce market imperfections. Well sometimes life is like that, especially in an area where individual future costs can't be calculated.

  • The Late P Brooks||

    If your doctor tells you you need some sort of test or treatment, and you ask "What's it gonna cost me?" the woman behind the counter is going to look at you like you just tracked dog shit across her white mohair carpet. And whatever answer you get will be wrong.

    There was an amazing and sad article a while back, which I have no idea how to locate, by a woman who needed some sort of cancer shot, and her story of trying to find out the real cost beforehand because she was on a high deductible plan, and it was coming out of her pocket. Ultimately, the number she was told was... a little low.

  • John||

    If your doctor tells you you need some sort of test or treatment, and you ask "What's it gonna cost me?" the woman behind the counter is going to look at you like you just tracked dog shit across her white mohair carpet. \

    Big fucking deal. When they bill that procedure to an insurance company, they sure as hell are going to ask that. And you don't get every procedure your doctor wants covered. Sometimes insurance companies don't cover procedures and they have set fees for such things. In short they do exactly the kind of thing you do dip shit.

  • Tulpa (LAOL-PA)||

    John, health insurance is like an all-you-can-eat buffet. If you eat one plate of food you're a chump.

    yes, the restaurant has an incentive to reduce their food costs, but they can't exercise it after they've sold you the buffet. They just have to price it in a manner they believe will be profitable, and given the risk inherent in doing so, that price will have to be higher than the average cost of the food eaten if it were paid for separately.

  • Virginian||

    An excellent analogy.

  • John||

    So what? As I explained below, because of the price uncertainty of health costs, you have to pool your risk by buying insurance. Not all markets are perfect.

  • Virginian||

    Except there are medical expenses which insurance is not the optimum payment model for. Your yearly checkup, for example.

    I carry car insurance in case a tree limb falls. I pay cash for oil changes. You see the difference?

    Using medical insurance to pay for a routine checkup is asinine. Because everyone is going to get one, so the risk pool doesn't offer any savings.

  • John||

    So what? You think it isn't. Some people think it is. Again, people are risk adverse and they tend to over pay to avoid it. That is why people probably carry to much insurance. But that is their choice. Lamenting the fact that they act in ways you think are irrational is nice and all but doesn't really mean anything.

    And if you are telling me that the government ought to stop mandating that insurance policies always include things, you will get no argument from me. But that is an indictment of the government meddling in the market not of the concept of health insurance.

  • Virginian||

    I just started watching Breaking Bad (I know, I'm late to the party) and Walter is asking how much this is going to cost, and his family is flipping the fuck out.

    It really is the only time asking what something costs will get you strange looks.

  • Dallas H.||

    Best. Show. Ever.

  • Adamsmith1776||

    If you really want to cut medicare and medicaid expesnes, apply this rule to all health care paid for by the Government, and have the savings go to it. If I have to pay for someone else's care, there is no reason why I should have to pay for their pain and suffering if they don't like what I gave them.

  • The Late P Brooks||

    the poor defenseless insurance companies just take it up the ass.

    The patient who does not have government subsidized employer provided insurance takes it up the ass. And now, due to cost shifting, instead of getting a cash discount, a guy who walks in and says, "I'm self-insured" pays absolute full tilt retail.

  • The Late P Brooks||

    Insurance doesn't drive the price of home repair or car repair up.

    Really? Are you sure about that?

  • The Late P Brooks||

    In short they do exactly the kind of thing you do dip shit.

    They do exactly the sort of thing I'd like to be able to do. That I'd like you, or anybody else to be able to do. But you have some sort of gold and jewel encrusted government health insurance, so you don't really give a fuck about the people who pay your salary. The insurance companies have access to information not universally available; and they have pricing power not available to individuals who are unable to obtain that information.

  • John||

    The insurance companies have access to information not universally available; and they have pricing power not available to individuals who are unable to obtain that information.

    And auto mechanics have access knowledge about cars most of us don't have. So what? That is their business. And the nature of medical care is such that you really don't want to live in a world without insurance. You can't predict what your medical costs will be. Maybe you will never spend a day in the hospital and drop dead of a heart attack one day. Maybe you will get a serious illness and run up a million dollars in bills. You have no way of knowing which will happen, so you can't plan for it. That is why you have to buy insurance and pool your risk. That way you can get some kind of fix on your costs.

    The insurance companies, since they pay the bills, have every reason to keep costs down to the extent they can. If they can't or won't do that, why is not every doctor a millionaire and then some? Hell just charged 25K for that procedure or 50K or a 100K, all of the "haggling is done' as you say and the insurance company will pay it, right?

  • Brandon||

    I think I just figured John out. He is not stupid, but once he makes up his mind he is willing to go to absurd lengths of mental gymnastics to avoid changing it.

  • John||

    Whatever. Libertarians are full on retarded if they think the health insurance is a bad thing. Insurance and pooling of risk is the only way people can fix costs and have a way of planning and living their lives without the risk being ruined by healthcare costs. Are you people actually so stupid that you believe that health care would become so affordable there would be no risk of great expense if we would just get rid of that evil FDR plot known as health insurance?

    This whole thing is an example of how Libertarians really don't understand markets. They honestly seem to think that there is a way to create a perfect market in a product that is both a life and death necessity sometimes and whose long term cost to the individual is impossible to calculate.

  • Brandon||

    Look at that, he managed to burn an entire field of straw men all by himself! And then he threw in some more red herrings and ad hominems! That must have been an exhausting comment.

  • John||

    Look at that, Brandan managed to completely miss the argument and has no idea what to say, so he does Hit and Run standby number 4, when in doubt and you don't like something, yell strawman and hope the subject changes.

  • ||

    It sort of helps how often some people use them.

  • Brandon||

    So what are you saying, John? Obamacare is a great idea because it enlarges the risk pool, and makes insurance more affordable for everybody? No, you're not saying anything. You're just slaying straw men and lobbing empty criticism at the libertarians in your head without actually saying anything of substance. You're defending the status quo by pointing out how one alternative would probably not be absolutely perfect.

  • John||

    What I am saying is that the idea that healthcare costs are high because of employee provided insurance (an article of absolute religious faith among Libertarians) is complete horseshit. It is horseshit for a couple of reasons.

    1. To believe that employer provided insurance drives up healthcare costs is to believe that insurance companies act like no other corporations in the world and somehow write checks with no regard to cost. And to the extent that insurance companies don't have perfect cost control, that is a price that is inherent in any market where the uncertain of costs mandates people pool their risks through insurance.

    2. The fact that people get a tax break on insurance has much less effect on people's willingness to purchase and pay for insurance than Libertarians tell themselves. People are risk adverse. They will over pay to avoid risks. For this reason, the demand for health insurance is very price inelastic. If you made people pay taxes on their health insurance, most would still get the same amount of health coverage and just do without something else. It would do little if anything to lower demand or lower costs.

  • John||

    People like P. Brooks operate under the delusion that if only he were allowed to write the check and assume all of the risk, he would get a great deal on the bone marrow transplant. Of course, for the moment at least, Brooks is free to self insure and bargain all he likes. Yet, few other than the really wealthy seem to do that. It is almost as if health insurance makes economic sense or something.

  • The Late P Brooks||

    Awesome.

  • Alice Bowie||

    I'm surprise that healthcare providers don't work like Credit Cards/Bank Loans:

    - The borrower cannot sue the Bank. All grievences must be handled in arbitration that almost always works in the banks favor.

    - The Bank can sue the borrower.

    Why don't we do it like that. The patient can't sue the doctor. The patient has to go to an arbitration hearling where the mediators are all doctors.

    The doctor can be free to sue the patient.

    And, after you get rid of the need for malpractice insurance, the doctors will just lower the prices in good faith.

  • John||

    We kind of have that in many states. In a lot of states you have to go before a panel and they have to sign off on it being malpractice before you file. And if they don't, you lose.

  • NL_||

    "High quality outcomes" = "mostly wealthy patients"

    Making tort liability yet another regressive regulation perversely framed as social justice.

  • Robert||

    Richard Epstein wrote about this decades ago: Patients should be allowed to contract for whatever standard of care they want.

  • Daniel1||

    The reason the $250,000 cap made no difference is because the insurance companies were lying to you about just how little most victims of malpractice really get. Quit falling for the lies of the insurance companies. You sound just like the cops wanting immunity so they can "do their job."

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